230 Final

Which of the following would be considered sentinel events that should be reported to the Joint Commission? Select all that apply.

-A client experiences a transfusion reaction after receiving the wrong type of packed red blood cells. -A client experiences nephrotoxicity and requires dialysis because of a medication error. -A client with dementia falls and suffers a hip fracture while trying to walk to the bathroom.

The failure to engage in which activities are considered a fatal flaw of leadership? Select all that apply.

-Communication with employees. -Self Improvement -Collaboration with colleagues.

List 4 physical symptoms of compassion fatigue.

-Feeling exhausted physically or psychologically -Feeling helpless, hopeless, or powerless -Feeling irritable, angry, sad, or numb. -A sense of being detached or having decrease pleasure in activities.

Meaningful use of certified EHR technology

-Improves quality, safety, and efficiency -Engages patients and family -Improves care coordination -Maintains privacy and security of patient health information

What should the manager do in completing an annual performance appraisal?

Base the appraisal on a standard to which all are held accountable.

A charge nurse in a large hospital, on a busy medical surgical unit, uses the autocratic style of leadership. Which tasks stated below best represent this style of leadership? Select all that apply.

-The charge nurse schedules a mandatory meeting in-service training on new equipment. -The charge nurse delegates nursing responsibilities to the staff. -The charge nurse dictates when breaks will be taken by all nurses.

The nurse is trying to navigate a difficult situation that involves an ethical dilemma. Which factors should be considered when assessing the quality of the nurse's ethical problem-solving process? Select all that apply.

-The number of alternatives that the nurse generated. -The process that was used to arrive at the decision. -The outcomes of the process.

A nurse oversees the care on a hospital unit in the role of an integrated leader-manager. What characteristics should this nurse exhibit? Select all that apply.

-The nurse attempts to motivate the employees. -The nurse's thinking's includes long-term issues. -The nurse has influence that goes beyond his/her own group.

What is your purpose in reporting this event?

-To identify what and how the event happened. -To have an end goal of being able to ensure that a preventable negative outcome does not occur.

A healthcare organization has experienced a rise in medical errors and has committed to implementing Leapfrog initiatives. What aspects of healthcare should the organization address? Select all that apply.

-Using the National Quality Forum, which endorses Safe Practice Scores. -Expanding the use of computerized physician-provider order entry. -Ensuring that hospital referrals are evidence-based. -Ensure that there is adequate ICU physician staffing.

Right task Right direction/communication Right person Right supervision Right circumstances

-job that is delegable for a specific patient -clear, concise description of the tasks including its objective, limits and expectations -right person is delegating the right tasks to the right person to be performed on the right patient -appropriate monitoring, evaluation, intervention, as needed and feedback -appropriate patient setting, available resources, and other relevant factors

You are acting as a preceptor for a newly graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide care to which patients?

1. A 28 year old with asthma awaiting discharge 2. A 43 year old with a tracheostomy needing tracheostomy care every shift

An experienced LPN under the supervision of the team leader RN, is providing nursing care for a patient with a respiratory problem. Which actions are appropriate for the scope of practice for a LPN?

1. Administer medications via metered dose inhaler 2. Obtain vital signs 3. Auscultate breath sounds

Which examples are essential components for delegating nursing care to an unlicensed assistive personnel? Select all that apply

1. The UAP can verbalize what information to report to the nurse 2. The UAP has sufficient knowledge and skill for completing the task 3. The nurse has clearly communicated instructions to the UAP

The Great Man Theory was the basis for most leadership research from 1900 until what year? What was the man theory about this type of leader?

1940, Some people are born to lead.

Which of the following patients would be eligible to receive medicare and medicaid benefits?

A 62 year old male who is disabled and has a monthly income of $1500

Steps of the budgetary process:

A- assess D- Diagnose (goal) P- Plan I- Implement E- Evaluate

A nurse was 20 minutes late returning from a scheduled lunch break and a colleague's break was consequently cut short. What response by the manager best demonstrates a laissez-faire leadership approach?

Allow the two nurses to dialogue about this event and observe for evidence of a satisfactory resolution.

Which client would be most likely to qualify for medicaid?

An adult client who ears $750 per month

In which situation would the nurse be justified in overriding a patient's right to confidentiality?

An older adult patient to the nurse that her son occasionally hits her.

A patient has made a decision about his plan of care. He tells the nurse, "I have decided stop my chemotherapy for my cancer treatment. I know that if I stop my cancer will probably grow again and I will ultimately die from my cancer." This is an example of which ethical principle?

Autonomy

A patient is actively involved in discussing a do not resuscitate order with the care team. What principle of ethical reasoning does this represent?

Autonomy

For a client who has sustained an injury causing recent blindness, which task would be appropriate to delegate to a nursing assistant?

Assist client to ambulate in hallway

A patient with COPD. Which intervention for airway management should you delegate to the NA?

Assisting the patient to sit up on the side of the bed

The nurse is caring for a client who has health insurance that is a form of managed care. What are likely characteristics of this clients health-care plan? Select all that apply:

Capitation Decreased emphasis on inpatient hospital care A focus on prevention of illness

As you take care of your patients on shift, you are aware that the communication technologies available to you throughout your day increase the efficiency and effectiveness of organizational communication. They also have a negative consequence if used improperly. Which of the following is a negative outcome of communication technologies?

Challenges to patient confidentiality.

A patient with a migraine headache suffered a seizure. After the seizure, what can you delegate to the CNA?

Check vital signs

The Health Plan Employer Data and Information Set (HEDIS) is being reviewed at your facility. What does HEDIS address for your facility?

Compares equality of care in managed organizations.

As a nurse manager that is familiar with the benchmark concept, you realize that this task, listed below, will best allow a healthcare organization to benchmark its performance:

Comparing the organization's performance with that of the best performing institutions or organizations.

When creating a clinical practice guideline for the management of aggressive behavior on a mental health unit, the nursing committee should perform which action first?

Conducting a search of the literature in regards to management of aggressive behavior.

A nurse manager is working in the context of an Accountable care organization (ACO). What task will this manager most likely perform?

Coordinating care for Medicare clients

The only treatment alternative left for a patient diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. The insurance company refuses to authorize payment for the $200,000 procedure, arguing that the money could be better spent providing well-baby screening for 2,000 residents in the service area. What does this decision by the insurance company reflect?

Utility

Leadership is appropriate for groups who work together for extended periods, it promotes autonomy and growth in individual workers.

Democratic

You are a novice nurse-manager and a member of a team that will oversee quality control in a healthcare organization. What action should you and other members of your team perform first considering the systematic process of quality control?

Determine the specific criteria and/or standards by which quality will be measured.

A nurse is considering the delegation of administering topical medications to the assistive personnel. What is the first question the nurse must ask oneself before doing so?

Does the nurse practice act and agency policy allow this delegation?

What is compassion fatigue?

Emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others.

What is the best course of action to stimulate broad participation of employees in quality control efforts?

Engage closely with the frontline staff, as well as managers and leaders.

A first semester nursing student asks the fourth semester nursing student to describe ethics as they are confused by its definition. The fourth semester nursing student replies:

Ethics is best described by what our conduct and actions should be regarding what is right and good.

You are the nurse leader on your unit. You are meeting resistance from other nurses on your unit as they do not wish to change the way that the shifts are scheduled on your unit. How can you, as a nurse leader, best address this resistance to change?

Explain the benefits of the change and elicit honest feedback.

Who does Spenser, the Medical Surgical Unit Manager, notify first of the drug diversion?

Follow hospital policy and state laws regarding reporting to law enforcement and Human Resources.

The clinical instructor directed the student nurse to care for a client whose potassium is 6.7. Which intervention is delegated to the nursing student?

Give kayexalate 15 g orally

A nurse manager has directed a registered nurse who is out of school for one year to become a member of the the instituitions policy and procedure committee. A goal in the nurse managers delegation is to assist the nurse to what?

Grow in the profession

What is the purpose of the diversion program?

Helps nurses with recovery and aid the employers and staff I coping with employee substance abuse.

As a nurse in the healthcare profession, you are using informatics on a daily basis, however, you may not realize all that informatics includes. Choose the answer below that best exemplifies techniques that the nursing informatics concept uses.

Informatics integrates nursing science with multiple information management and analytical science.

What three steps, according to Tamara McCleary, are used for engaging employees through relationship building?

Invest the time, get the data, and evaluate the progress of employee engagement.

The _____________ is a United States-based nonprofit tax-exempt organization that accredits more than 22,000 US health care organizations and programs.

Joint Commission

This person inspires change

Leader

This person requires risk taking

Leader

This person uses abstract thinking

Leader

What is the definition of leadership?

Leadership is the process of guiding, educating, motivating, and directing others.

What does research tell us about Magnet designated facilities?

Magnet facilities have better patient outcomes, shorter lengths of stay, higher patient satisfaction, and higher nurse job satisfaction.

The nurse-manager has learned, through the staff, that there is a conflict between a non responsive patient's family members, in regards to the best plan of care for the patient. The manager recognizes the complex ethics of this situation. What is the manager's best action?

Make contact with the hospital's ethics committee for guidance in this situation.

This person requires blind commitment to completing the task at hand

Manager

This person requires specific tasks to be accomplished

Manager

Stewart starts his day by reviewing patient new admissions, medicare and medicaid reimbursement policies, reviewing facility costs and expenditures, and addressing an employee group that has discontent with the facility policy on mask wearing. What role does Stewart represent?

Manager role

A nurse is applying the moral decision-making model to a dilemma involving a colleague's possible dishonesty in documentation. What is the nurse's actions? Put your answers in the correct order.

Massage the dilemma Outline options Review criteria and resolve Affirm position and Act Look back and evaluate

A nurse has repeatedly witnessed a physician being dismissive of client's reports of pain and anxiety. The nurse recognizes that the best action would be to address this behavior with the physician, but the nurse strongly suspects that these concerns would be dismissed. What phenomenon is this nurse experiencing?

Moral Outrage

You are caring for a patient that has a mental illness that the healthcare team has deemed as a threat to self and others. It may be justified to take away the patient right to :

Self-determination

Wha is the primary function of OSHA?

Organization that ensures safe and healthful working conditions for workers by setting and enforcing standards.

A healthcare organization has adopted a system of peer review for the first time. How can the success of this system be best promoted?

Orient employees thoroughly to the purpose and process of the new system.

You have led a smoking cessation clinic session and 38% of the people who attended your clinic stopped smoking 1 year post clinic session. What type of audit provided this type of data?

Outcome

Stephanie is an experienced UAP. George is a RN with 10 years experience. George has some family issues and leaves the unit and ask stephanie to keep an eye on all of his 5 patients, plus get vitals and blood sugars for the other 15 patients on the unit. This is an example of:

Overdelegating

The multidisciplinary team is considering if your patient is competent to make his/her own decisions. What principal would help the team to make that decision?

Paternalism

As part of the quality control process in your facility, you are aware that managers have set standards for performance and are assessing whether these standards are being met. It has been determined that several standards are not being met. What is the priority response to this finding?

Perform interventions that will correct the deficiencies.

During the budgetary process, a nurse-manager and the other members of the fiscal planning team are considering factors that may affect the accuracy of the budget. What factor should the team prioritize?

Possible changes in reimbursement policies

Of the four major factors that affect health care-medical services are said to have the least effect. Yet, the U.S. health care system remains reactionary with high-cost, high-technology, and disease specific "sickness care." This statement supports the needs for increased investment in:

Primary prevention

You are a supervisor in an organization that has total quality management (TQM) as the basis for the organizations goals and objectives for quality control. How can you practice TQM principles on the unit?

Promote teamwork rather than individual accomplishments. You agree with the elimination of the annual rating or merit system.

A nurse in an intensive care unit places a request with the nurse manager to modify the nurse's work schedule. The nurse desires to return to college and obtain an advanced nursing degree. Which action by the nurse manager in response to the nurse's request illustrates the transformational style of leadership?

Rearranging the nurse's schedule so that the nurse can attend college.

A nurse educator has approached the managers of a hospital unit in regards to wanting to conduct research into a new nursing intervention. To ensure that the rights of clients who may participate in the research are protected, the managers should:

Refer the educator to the institutional review board.

Which activity best demonstrates a nursing unit manger's attention to ANA standards for ethics required of that position?

Refers complex dilemmas to the institution's ethics board.

The RN is delegating the task of assisting a post-op client to the bathroom to the CNA. The nurse witnessed the CNA correctly perform the task on previous occasions and knows the CNA is competent to perform the task. The nurse has communicated how to get the client out and back into bed and told the CNA not to allow the client to bear weight on the left leg. The nurse validated the activity was completed and gave the CNA feedback. Which delegation did guideline did the nurse omit?

Right circumstance

What is the best process that should be implemented in order to identify and correct the error?

Root cause analysis

Delegation is the process of transferring work to subordinates. A nurse manager may appropriately delegate which task?

Scheduling staff assignments for the next month

Through the ORYNX initiative, what role has The Joint Commission assumed in ensuring quality at the organization level?

Standardizing clinical outcome data collection for core measures.

A nurse-manager is overseeing an organization that uses the Nursing Minimum Data Set (NMDS). What will the use of the NMDS achieve?

Standardizing the collection of nursing data for use by multiple users.

The nurse manager has been approached by an angry employee whose vacation request was denied. What should the manager do when communicating with this employee?

State, "I understand that you are angry that your vacation request wasn't approved" and allow the employee the opportunity to express what she wants from the manager.

If you were Linda's nurse manager, and you felt that she was having some compassion fatigue, what constructive feedback could you provide?

Talk to Linda and provide her with honest feedback and discuss your concerns.

Big Data

The accumulation of health-care related data from various sources, combined with new technologies that allow for the transformation of data to information, knowledge, and ultimately to wisdom.

A client is a member of an HMO and has chronic shoulder pain from an old injury. The client decided to pursue shoulder surgery and the HMO has required a utilization review. What will this review focus on?

The cost and benefits of the proposed surgery

Usability

The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specific context of use.

A nurse who is newly hired to manage a busy pediatric office is encouraged to use a transactional leadership style when dealing with subordinates. Which activities best exemplify the use of this type of leadership?

The manager institutes a reward program for employees who meet goals and work deadlines.

What aspect of a clients care is most likely influenced by the Patient Protection and affordable care act (PPACA)?

The number of health insurance plans that the client can choose between

How is nurse #1 demonstrating an alteration in professionalism?

The nurse is demonstrating unethical and unlawful behavior by not administering the medication to the client.

The nurse is caring for a post operative patient whose pain is not being relived by the analgesic that is ordered for the patient. When using the SBAR tool to communicate to the physician, how does the nurse best communicate the "A" component of the SBAR tool?

The patients pain control may be inadequate as she has been rating her pain level as a 9 out 10 for the past hour.

A nurse-manager and several colleagues are reviewing the results of of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. These results will allow the team to make what assessment?

The patients perspectives on the care they received.

To control costs and decrease the money lost from uncharged supplies, the hospital has decided to move to a controlled distribution system for supplies. This requires the nurses to attend several in-service sessions to learn how to work with the new system. The nurses are complaining that they do not have time to "learn another thing." In this instance, if change is to be successful, it must be accepted by:

The persons who will be involved.

A nurse is integrating the Nursing code of ethics when making a decision about the best response to a challenging situation. What information will the nurse be able to obtain from this document?

The principles that are most valuable in nursing practice.

A nurse is facing an ethical dilemma about whether to report a colleague's offensive comment, an action which is likely to jeopardize their relationship. What is a characteristic of this nurse's ethical dilemma?

The situation involves 2 or more undesirable alternatives.

Which characteristic of a planned change is most likely to threaten its success?

The suggested change is introduced to staff after the plan has been formalized.

The policy in a long-term care facility specifies that immobile residents should be repositioned at least every 2 hours. Despite this policy, it is well known that many residents endure long periods without being repositioned. How should the nurse best interpret this situation?

There is a need for actions to address this theory-practice-ethics-gap.

The charge nurse assigns the nursing care of a patient who is one day post op after a left BKA to an experienced LPN, who will function under your supervision. When you instruct the LPN, what will you describe as the major focus of of care today?

To monitor for signs of sufficient tissue perfusion

The nurse who manages an ambulatory clinic is well known as being a visionary leader who is skilled at empowering others with this vision. What type of leader is this nurse?

Transformational

Anne wanted to simplify the current method of ordering missing medications. She devised what she thought was an excellent idea and presented her plan to the nurse manager on the unit. Her idea was rejected. What step in the process of change did Anne forget to follow?

Unfreezing

The manager on a hospital unit has highlighted some of the large gaps between desired client outcomes and actual client outcomes. What component of Lewin's change theory is the manager demonstrating?

Unfreezing

a nurse continuously comes to work and shift report at least 20 minutes late. What are 4 progressive discipline steps to be administered for non serious infarctions?

Verbal Admonishment, Written Admonishment, Suspension, and Dismissal.

A staff member asks you as the unit team leader, "Why must organizations continue to apply changes?" You reply...

Without change, there will never be renewal and the organization may stagnate and die.

The nurse is planning to educate a client for medication therapy. What is an essential part of the nursing process?

that the nurse perform all teaching and evaluating